Research and Clinical Trials

Over the past two years, the Maimonides Bone & Joint Center has experienced a tremendous growth in its research efforts. Laboratory space, grant funding and dedicated personnel, in addition to a renewed commitment by department leadership to expand research efforts, have led to the successful completion of over 25 projects in a variety of areas. Several projects have been recognized and awarded by national and international societies. Residents in training, as well as faculty, are provided with necessary resources and mentoring on study design, statistical methods, data analysis, and manuscript preparation. Completed and ongoing projects span the gamut of orthopedic specialties with a balance of basic science, bench, animal and clinical research.

Carpal Tunnel Syndrome

Studies on carpal tunnel syndrome have focused on the effects of the disease on sleep patterns. It has been well established that inadequate sleep has detrimental effects on overall health, however, these effects have never been quantified. A preliminary study of 50 carpal tunnel patients showed a significant correlation to disease severity and sleep disturbances. Ongoing research is geared toward establishing guidelines and monitoring the effects of treatment. Another study on carpal tunnel patients evaluated the compliance and effectiveness of non-operative management of the condition with night splinting and found that, while symptoms improved, many patients required surgery to alleviate the condition.

Upper Extremity Surgery

Other studies in upper extremity surgery have focused on the use of fluoroscopy as opposed to traditional X-rays in establishing diagnoses in a variety of conditions. Fluoroscopy, which offers lower dosage radiation, was found to be superior in determining severity of carpal malalignment in wrist sprains and assessing the severity of thumb instability following ligament injury. In another study, fluoroscopy was found to be superior to x-rays in assessing the position of fixation hardware in fractures of the wrist. The latter study was the recipient of the Best Poster Award at the British Society of Surgery of the Hand Annual Meeting.

Spine Surgery

In the field of spine surgery, studies are being performed on the use of a saliva test to evaluate DNA markers which can more effectively predict the progression of adolescent idiopathic scoliosis than multiple consecutive x-rays. Children can now be exposed to much less radiation, and parents can be provided with objective data in order to help make crucial decisions concerning operative management. Another study on scoliosis has evaluated using less hardware in fusion of the spine, decreasing operative time and significantly reducing costs.

Cartilage Damage and Regeneration

Another avenue of research has been in the area of cartilage damage and regeneration. One study evaluated the effects of certain medications used to treat the symptoms of arthritis and found that some medications actually can lead to further damage of the cartilage structure. In an animal study on rabbits, a previously unknown growth factor in human cartilage Granulin – Epithelin Precursor (GEP) was found to have promising results in regeneration of cartilage. These studies have helped gain further insight into the causes and potential treatments of arthritis. The latter study received the Best Research Award at the Eastern Orthopedic Association Meeting, and was invited for special presentation at the American Academy of Orthopedic Surgery.

Osteoporosis

Research in the area of osteoporosis has become our next challenge. Osteoporosis-related fractures are seen in excess at Maimonides, and can lead to significant morbidity and mortalities. The prevention of osteoporosis through proper diagnosis and medical management has been reported to be extremely poor throughout the country with estimates indicating that only 20% of patients receive the proper treatment. An increased awareness of the disease is needed in order to make any progress in combating its effects. To this end, we are studying the compliance rates for treatment in identified patients and increasing awareness through patient and physician education. At the recent New York Orthopedic Society symposium, “Quality and Outcomes 2009: A Practitioner’s Guide to Documenting Excellence of Care,” our work at Maimonides entitled “Thinking a Step Ahead: Diagnosis and Management of Osteoporosis for the Orthopedic Surgeon” was given the Best Poster Award. Further work in this area will involve the development of a database of patients to follow the effects of treatment and basic science work as well as utilizing nanotechnology to study the effects of various drugs on the prevention of the disease.

Safer Anesthesia For Patients With Hip Fractures

Nearly a quarter million hip fractures occur in the US each year, many of which occur in some of our sickest patients. As the population ages, this number will increase. Maimonides Medical Center treats a large number of hip fracture patients and continues to look at ways to improve the outcome following this devastating injury. Surgery is usually needed to fix or replace the hip, and requires some form of anesthesia. The only choices available are general anesthesia or some kind of regional block such as a spinal. Each of these choices has an associated risk for these sick patients.

At Maimonides, surgeons and anesthesiologists have been looking into safer methods of providing anesthesia for those patients who are at high risk. Using ultrasound-guided techniques, Maimonides physicians have placed nerve blocks allowing these sick patients to have the surgery they need while decreasing their risks.

In a study recently presented at a national orthopedic conference, 14 patients received this type of anesthesia and were able to have the surgery which allowed them to walk again. The anesthesia used ultrasound to help the doctors locate the nerves that provide feeling to the leg. Long and short acting anesthetic agents such as lidocaine were injected directly around the nerves, allowing the surgeons to perform the operation without pain and without the risks of general anesthesia.

The efforts of the department could not have been successful without funding from the Maimonides Research Foundation and from other philanthropic organizations. To contribute to the Department of Orthopedic Surgery, please contact Viktoriya Furina at vfurina@maimonidesmed.org